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Like some 47 million other Americans, Nancy Sowa (pictured) doesn't have health insurance. So when her doctors last year told her she needed a total hip replacement, the office manager for a non-profit did what a growing number of U.S. citizens are doing: She headed abroad. At Wockhardt Hospital in Bangalore, India, the 56-year-old was put up in a hospital "suite" far swankier than what she would typically find in the U.S., with a computer, fridge, cable TV, sitting area and an extra bed for her travel companion.

More to the point, the two-hour surgery in July, performed by an orthopedic surgeon trained in the U.S. and Australia, was a success. Four months later, the Durham, N.C. resident is feeling like her old self again, going for long hikes and planning her next vacation. The final tab for the procedure, including rehabilitative therapy and round-trip airfare for two? $12,000. That's a fraction of the $45,000 to $90,000 she had been told the surgery would cost at home. "I wouldn't have been able to do the surgery in the United States," says Sowa. "I didn't have to explore taking out a second mortgage or tapping family members because I had this other option."

With Americans able to save 50% to 90% by going to places like India, Thailand and Costa Rica, the uninsured aren't the only ones considering the medical tourism option. Increasingly, U.S. employers, faced with soaring health care costs that are expected to rise another 9% in 2010, are sending their workers overseas for care. Many of the companies exploring the option are small- to medium-sized firms that are self funded -- meaning they're responsible for paying out their own health care claims.

Insurers like Blue Cross Blue Shield are getting into the act, too. For good reason: Even when employers or insurers waive co-pays and deductibles and throw in airfare and spending money for the patient and a companion -- some of the typical incentives offered to employees who have medical procedures done abroad -- they can still save $40,000, $50,000 or $60,000 per surgery, depending on the procedure.

No Longer Just for Face Lifts and Tummy Tucks

"The biggest driver is cost savings," says David Boucher, who leads Companion Global Healthcare, the company launched by Blue Cross Blue Shield of South Carolina in 2007 to provide health tourism plans to employers. "But when members come back, they also tend to say really good things about their experience."

Mindful that they can also save between 50% to 90% on medical costs, employers and insurers are sending insured workers overseas for procedures. To see the hospitals abroad that could soon be in your company's health plan, click here.

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Getty Images / Jupiter Images

In the past, medical tourism was primarily for the wealthy who jetted off to Brazil and South Africa for face lifts and tummy tucks. More recently, however, the middle class and uninsured have also been boarding planes for elective surgeries they couldn't afford in the U.S.

In fact, Americans are becoming increasingly nonchalant about hopping continents to go under the knife. Some 180,000 Americans went abroad for treatment in 2007, says Josef Woodman in his book Patients Beyond Borders.As employers and insurers start offering medical travel as part of their health plans, those numbers could explode.For now though, the number of U.S. employers that are making places like Bumrungrad International hospital in Bangkok "in network" is still small. Renée-Marie Stephano, president of the Medical Tourism Association in West Palm Beach, Fla., estimates that number of employers that are offering treatment options abroad is less than 10%. And, of the nearly 350 companies Companion Global Healthcare has signed on through its affiliates, no more than 30 employees so far have made health trips abroad, says Boucher, who is based in Columbia, S.C.

"We're very happy with where we are," Boucher says. "It's very clear from the numbers that employers are not just jumping into the deep end of the pool. They are taking an appropriate, measured approach to it."

Sending Patients Abroad Spurs Backlash

They have reason to be cautious. In 2006, Blue Ridge Paper Products in Canton, N.C. abandoned plans to pay for an employee to have shoulder and gall bladder surgery in India after his union raised questions about the quality of care and medical liability overseas, The New York Times reported. The employee had volunteered to go in exchange for a share in the savings that would have come from doing the work in India, the paper said. But the United Steelworkers union sent a letter to the U.S. Senate and House committees overseeing health care saying it opposed what it called a "shocking new approach" of sending workers to low-cost counties for health care -- and it demanded the worker get a health care option within the United States, The Times reported.

Besides questions regarding quality of care and legal recourse, other concerns have come up. Among them, with cheap care overseas beckoning, will employers discourage their employees from seeking treatment in the U.S. by raising deductibles or other methods? And what will follow-up care be like back at home, especially if there are complications after surgery abroad?

"If you look at the American College of Surgeons, they are reluctant about having to pick up after another doctor's mistakes, especially by one not in this country," says Judy Dugan, research director with the Santa Monica, Calif.-based consumer advocacy group Consumer Watchdog.

Dugan agrees the cost of medical care is out-of-hand in the U.S., but she says industry and policy makers should look for ways other than medical tourism to bring it down. "If medical globalization were to become sizable in the U.S., it would no doubt cost good jobs in the country, from the top surgeon on down to the person who makes your bed," she says. "Do we really want to go with the salary bottom overseas, rather than look for cost containment in the United States?"

Not Everyone Boards a Plane

Most employers use medical tourism facilitators, which typically handle travel and health care arrangements for their employees. Despite lingering stereotypes of hospitals in developing countries as squalid facilities overrun with the deathly ill, many say these outfits actually offer cutting-edge care equal to or superior to what many hospitals offer in the U.S. The facilitators say they work exclusively with hospitals accredited by globally-recognized accreditation agencies, such as the Oakbrook, Ill.-based Joint Commission International.

"There are top quality hospitals all round the world, not just in the U.S.," says Tom O'Hara, president of medical tourism facilitator Surgical Trip, based in Boca Raton, Fla.

If your employer paid your co-pay and deductible to get surgery overseas, would you go?

Yes

11791 (49.6%)

No

3356 (14.1%)

Depends on the type of surgery

8640 (36.3%)

The goal is to get people the best quality care at a cheaper price, not to pack planes with patients, medical tourism operators say. Individuals deemed too sick to make the trip are turned away, says Companion Global Healthcare's Boucher. Has his company ever had any problems with patient care abroad? "Not a one," he says.

David Honaker, a 60-year-old medical tourist, says Americans are misguided if they believe the U.S. has a monopoly on quality medical care. The uninsured business owner traveled to Clinica Biblica Hospital in Costa Rica in April 2009 to have spinal surgery. The procedure ended up costing him about $12,000 versus the $80,000 it would have set him back at home in Carthage, Mo.

"I think there is a huge misconception," Honaker says. "The reality about the quality of care abroad has been stifled because the U.S. wants that dollar."

Could Medical Tourism Spark Competition Among U.S. Providers?

Few employers are eager to discuss their actual health travel plans, especially after the Blue Ridge Paper Products incident three years ago. "For their own reasons, they want to be under the radar," says Woodman, the Patients Beyond Borders author.

Hannaford Supermarkets, however, was willing to talk. Last year, the Portland, Me.-based supermarket chain gave its 27,000 employees the option to travel to Singapore's National University Hospital for hip and knee replacements. No deductible or co-pay and free travel for a companion was the deal.

Since the program launched in January 2008, however, nobody has taken Hannaford up on its offer, says spokesman Michael Norton. The reason? After all the press the company received, a couple of domestic providers stepped forward and lowered their prices to compete with Singapore.

"You can sort of see the dynamic," says Norton. "It will probably be less likely that we get any traffic on the overseas option."

Going forward, there are several factors that could affect the spread of medical tourism. Most experts agree the numbers will keep climbing, with Deloitte LLP forecasting that as many as 1.6 million Americans will head overseas for care in 2012. While high, that's a far cry from the 6 million the consultancy had predicted -- before the global recession curbed demand for elective surgery -- would be medical traveling three years from now.

One looming uncertainly is, what happens if the U.S. passes legislation enacting universal health care coverage? Less people might travel overseas if they are covered for care -- even if it's more expensive -- in the U.S., says Saroja Mohanasundaram, CEO of Newton, Mass.-based medical tourism facilitator Healthbase. People might still travel if certain procedures like bariatric and cosmetic surgeries aren't covered, she says. "There may be wait lists in the U.S. or other issues," she adds.

As far as Nancy Sowa is concerned, she's not convinced universal coverage would have changed her mind about going to India. "Even if I had insurance, I'm not sure I would have made the choice to stay in the U.S.," she says. While that may be good news for corporate benefits administrators seeking to trim costs, it may concern medical tourism critics who don't want to see the trend become a fixture in U.S. health care.